1100 PACIFIC AVE EVERETT BONE AND JOINT 2022-01-20

PERMIT APPLICATIO• BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION EVERETT CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET,EVERETT,WA 98201 WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS:1100 Pacific Avenue PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: Everett Bonn Joint, Proliance Surgeons TENANT BUSINESS NAME(Commercial): OWNER MAILING ADDRESS: sTREET 1100 Pacific Avenue, Ste. 100 c,T,, Everett STATE WA Zip 98201 OWNER PHONE: 425-317-8535 OWNER EMAIL: CONTRACTOR NAME: Newland Construction CONTRACTOR ADDRESS: STREET 3300 Chestnut Street cm Everett STATE WA Zip 98201 CONTRACTOR PHONE: 425-259-9191 CONTRACTOR EMAIL: CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR D OTHER(Please Specify) Architect CONTACT NAME: CONTACT PHONE:425-259-0868 Devin Saylor CONTACT EMAIL: devin@bnharch.com BUILDING INFORMATION Existing Use of Building: B Occupancy Outpatient Medical Clinic Contract Price of Work:$150,000.00 Proposed Use of Building: B Occupancy Outpatient Medical Clinic Heat Source: OGas ❑Electric DOther BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: ©Commercial ❑Accessory Structure Type of Project: ONew ❑Addition ©Remodel ❑Repair ✓❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use DESCRIPTION OF WORK: Minor remodel of two existing rooms to replace existing casework with new casework, new flooring and installation of new instrument washer/disinfector unit. ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Fixture Fixture Fixture Fixture Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) Forced Air Systems Other: Medical Gas Water Valves or Fixtures Gas Fireplace/Insert/Log Roof Drains Water Heater SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other: Water Suppression System No.of Heads Chemical Suppression System No.of Heads ACKNOWLEDGEMENT..I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RC and 296.200A WAC. 41/ City of Everett Official Use Only Alb A PERT ER oi 1 , OO`_ ) 11-1-2019 wner/Authorized Agent Signature / Date (Revised /10/2018) l/Z